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Clínica de Epilepsia | Trabalhos em Congressos

LESIONAL AND EPILEPTOGENIC AREAS IN PATIENTS WITH MULTIFOCAL NON-CONTIGUOUS CORTICAL DISPLASIA
RESULTS FROM INVASIVE RECORDING AND SURGERY

Arthur Cukiert, Cassio Forster, Viviane Ferreira, Leila Frayman, Jose Buratini.

Epilepsy Surgery Program- Hospital Brigadeiro and Sao Paulo Epilepsy Clinic, Sao Paulo SP, Brazil

RATIONALE- Cortical displasia is often associated with refractory epilepsy. Areas with cortical displasia may be extensive but they are usually contiguous and the epileptogenic area usually includes the lesion and its surroundings. This paper describe our findings in patients with multifocal non-contiguous areas of cortical displasia.

MATERIAL- Two patients were included in this series. Patient I- An 8 years-old boy presented with seizures from the first year of life. Seizures were characterized by tonic posturing of the left arm and head rotation to the left. EEG showed a right frontal focus with intense secondary bilateral synchrony. Ictal recordings showed a right frontal onset. MRI disclosed extensive cortical displasia over the right frontal lobe and heterotopic, non-contiguous nodules in the basal ganglia (figures 1 and 2) . He was submitted to an extensive frontal resection but the basal ganglia lesions were left in place. Patient II- A 24 years-old man presented with seizures since the age of 8 years. Seizures were simple partial motor or complex partial with forced head rotation to the left. Interictal and ictal EEG localized an extensive right fronto-temporal epileptogenic area. MRI disclosed an area of cortical displasia in the right anterior cingulate gyrus and a second, non-contiguous, in the right pre-motor cortex (Figures 3 and 4). He underwent invasive recording with subdural plates covering the entire fronto-temporal neocortex. Seizures originated exclusively from the pre-motor and motor strip areas. No spiking was noted related to the cingulate gyrus lesion (Figure 5).

RESULTS- Patient I has been seizure-free after surgery. No post-operative event or EEG finding could be correlated to the remaining basal ganglia lesion. Patient II is awaiting surgery.

CONCLUSION- Multifocal, non-contiguous areas of cortical displasia may disclose multifocal epileptogenic activity but seizures may arise exclusively from one focus . In such instances, these epileptic syndromes may be amenable to surgery with good results.